title: Reconstruction of a complex midface defect from excision of a squamous cell carcinoma, according to regional aesthetic units.
abstract: Extensive squamous cell carcinoma involving the skin of the upper lip, nasal ala, and cheek is relatively rare. Although numerous reconstruction techniques for the midface including lip, nose, and cheek have been described in the literature, reconstruction of large defects in this area continues to be challenging, as it is difficult to obtain satisfactory results with single-stage surgery. This case report concerns a 53-year-old woman with squamous cell carcinoma extending from the upper lip to the alar base and the cheek. It describes a step-by-step surgery undertaken according to defined regional aesthetic units of the face using several reconstruction methods, including a microvascular free flap, forehead flap, and conchal cartilage graft, rather than multistage reconstruction surgeries after first immediate reconstruction. Satisfactory functional and aesthetic results were achieved despite the extensive facial defects.
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital. Electronic address: kogay-ora@h.u-tokyo.ac.jp.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kawase-Koga
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital.
authors.forename: Hideto
authors.initials: H
authors.lastname: Saijo
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Hoshi
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takato
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003952:Diagnostic Imaging; D004425:Ear Cartilage / Q000637:transplantation; D004954:Esthetics; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures / Q000379:methods*